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Multicenter Study
. 2019 Feb 1;104(2):213-222.
doi: 10.1210/jc.2018-01083.

Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia

Jinhui Ma  1 , Kerry Siminoski  2 , Nathalie Alos  3 , Jacqueline Halton  4 , Josephine Ho  5 , Elizabeth A Cummings  6 , Nazih Shenouda  4 , Mary Ann Matzinger  4 , Brian Lentle  7 , Jacob L Jaremko  2 , Beverly Wilson  2 , David Stephure  5 , Robert Stein  8 , Anne Marie Sbrocchi  9 , Celia Rodd  10 , Victor A Lewis  5 , Caroline Laverdière  3 , Sara Israels  10 , Ronald M Grant  11 , Conrad V Fernandez  6 , David B Dix  7 , Robert Couch  2 , Elizabeth Cairney  8 , Ronald Barr  1 , Stephanie Atkinson  2 , Sharon Abish  9 , David Moher  12 , Frank Rauch  9 , Leanne M Ward  4 ; Canadian STOPP Consortium
Affiliations
Multicenter Study

Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia

Jinhui Ma et al. J Clin Endocrinol Metab. .

Abstract

Objective: To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL).

Methods: Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status.

Results: Baseline height z score ± SD was 0.3 ± 1.2. It fell by 0.5 ± 0.4 in the first 6 months for boys and by 0.4 ± 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P = 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m2 increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01).

Conclusions: GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.

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Figures

Figure 1.
Figure 1.
Disposition of patients from baseline to 6 y.
Figure 2.
Figure 2.
Trajectories for (a) height z scores at baseline and every 6 mos, (b) height velocity z scores, and (c) average GC daily dose. For height velocity and average GC daily dose, the 6 on the horizontal axis indicates the time interval from baseline to 6 mos, the 12 indicates the time interval from 6 to 12 mos, and so on. Girls are shown in white bars and boys in gray bars. Minimum, first quartile, median, third quartile, and maximum values are shown in the boxplot. The horizontal solid black lines within the box indicate the median.
See this image and copyright information in PMC

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